Large diversity in vaginal microbiota with disruption of normal flora found in PCOS patients: Study
Polycystic ovary syndrome, is a heterogeneous and complex issue that affects women's reproductive and metabolic health. It is considered to be the most prevalent female endocrine abnormalities. Although there is a geographical variation in the incidence of PCO but the incidence rate is thought to be (3-10%). PCOS has an effect on many facets of a woman's physical wellbeing,...
Polycystic ovary syndrome, is a heterogeneous and complex issue that affects women's reproductive and metabolic health. It is considered to be the most prevalent female endocrine abnormalities. Although there is a geographical variation in the incidence of PCO but the incidence rate is thought to be (3-10%). PCOS has an effect on many facets of a woman's physical wellbeing, including long-term consequences that extend much further reproductive age.
The cause of PCOS is unknown; however, various factors have been reported as contributing to the development of a hormonal and metabolic dysfunction that can contribute to the onset of this syndrome. A few studies suggest that alterations in the microbiome may be contributed in the genesis of PCOS. Menstrual irregularity, hyperandrogenism, and polycystic ovary morphology are some of the parameters used to diagnose PCOS (PCOM).
PCOS has a significant influence on subsequent women's health because it triggers several metabolic disorders such as insulin resistance (IR), diabetes, and obesity. When studying the pathogenesis of PCOS, it's critical to look at alterations in metabolic states in a comprehensive approach. Although latest study demonstrates that Gut Microbiomes disturbances are connected to the onset and progression of metabolic diseases, but the correlation between different vaginal microbiome and the etiology and pathogenesis of PCOS is poorly understood.
The human microbiome includes all parasitic microorganisms found on the skin, throughout the digestive, respiratory, and urogenital tracts. The vaginal microbiota have a positive interaction with their host and have a significant influence on health and disease.
A case- control study conducted by Ahmed included 120 participants, 60 had been diagnosed as having PCOS according to the Rotterdam Criteria for diagnosis of PCOS and the other 60 are healthy females visiting the outpatient private clinics in Hay Aljameaa/ Al-Harthya in Baghdad from October 2020 till march 2021 for different medical problems.
Both study groups had L. crispatus in their vagina, while for L. jensonii 93.33% of control group have this microbiota while only 66.66% of PCOS group have it, L. gasseri presented in the vagina of 80% of controls and only 38.33% of PCOS. S. aureus in 41.66% of PCOS group and only 3.33% of control group, S. epidermidis presented in 25% of PCOS females while it not presents in control group.
Str. Pyogenes presented in 36.67% of PCOS group and absent in control group (p< 0.0001), Str. Agalactiae presented in 26.67% of PCOS group and 1.67% of control group. Bacteroides presented in 30% of PCOS cases and only in 1.67% of controls (p< 0.0001).
For other types of vaginal microbiota e.g. Gardnerella vaginalis,authors found that it presents in high percentage of PCOS group 66.67% and absent in females of control group, Prevotella spp presents in 55% of PCOS group and only 3.33% of control group, Mobiluncus spp and Fusobacterium spp were absent in both study groups.
For candida species, C. albicans presents in 30% and 6.67% of vagina of PCOS and control group respectively.
In this study researchers found that both groups of the study had abundant Lactobacillus species in their vagina as most of similar studies found that in the majority of women, those species are the most common vaginal bacteria. L.crispatus was found in all participants of both groups, but its concentration may be altered as many other microbiotas was detected in the HVS of the first group, those microbiotas was not detected in control group, L. jensonii and L. gasseri was detected in more frequent in control group than PCOS group.
The study of vaginal inhabitants of PCOS patients and healthy controls shows that PCOS patients' microbiomes are more diversified.
Authors found frequent detection of Candida albicans in PCOS patient swabs which may be explained by glucose intolerance or insulin resistance precipitated by PCOS pathology that provide a good environment for candida for growth and multiplication. Streptococcus pyogenes, Str. Agalactiae and Bacteroides were also detected significantly in swaps of PCOS patients that other studies failed to detect.
In this study, authors detected many other microbiotas e.g., Coryneforms (Diphtheroids), Klebsiella, Ureaplasma, Escherichia coli and Trichomonas vaginalis although the difference is not statically significant between both study group but these results reflect the huge variation of the vaginal inhabitants and disruption of vaginal flora in PCOS group.
"There is large diversity in the vaginal microbiota with disruption to normal flora in PCOS affected patients so we need further studies to evaluate the relationship between the microbiota and different PCOS symptoms. There is large diversity in the vaginal microbiota with disruption to normal flora in PCOS affected patients so we need further studies to evaluate the relationship between the microbiota and different PCOS symptoms."
Source: Ahmed / Indian Journal of Obstetrics and Gynecology Research 2021;8(4):443–447
MBBS, MD Obstetrics and Gynecology
Dr Nirali Kapoor has completed her MBBS from GMC Jamnagar and MD Obstetrics and Gynecology from AIIMS Rishikesh. She underwent training in trauma/emergency medicine non academic residency in AIIMS Delhi for an year after her MBBS. Post her MD, she has joined in a Multispeciality hospital in Amritsar. She is actively involved in cases concerning fetal medicine, infertility and minimal invasive procedures as well as research activities involved around the fields of interest.